POS0967 THE IMPACT OF PSORIASIS ON THE CLINICAL CHARACTERISTICS, DISEASE BURDEN AND TREATMENT PATTERNS OF PERIPHERAL SPONDYLOARTHRITIS: AN ANCILLARY ANALYSIS OF THE ASAS-perSpA STUDY
Authors: T. Izci Duran, M. Torgutalp, V. Rios Rodriguez, F. Proft, C. López-Medina, M. Dougados, D. Poddubnyy
Journal: Annals of the Rheumatic Diseases (2022)

Background Psoriasis (PsO) is one of the common extramusculoskeletal manifestations of spondyloarthritis (SpA). There is a natural overlap between peripheral SpA (pSpA) and psoriatic arthritis. However, there are several unmet needs in patients with pSpA who cannot be classified otherwise (i.e., patients without PsO and without axial involvement) due to a lack of formally approved treatment options and lack of evidence of efficacy of different drug classes in this specific population. Objectives To evaluate the clinical characteristics, disease burden, and treatment patterns of pSpA patients with and without PsO using data from the cross-sectional ASAS-perSpA study. Methods We analysed 433 patients who had a diagnosis of pSpA according to the rheumatologist’s diagnosis from the ASAS-perSpA cohort. A personal history of PsO was defined as the presence of signs of PsO on physical examination, psoriatic nail dystrophy, including onycholysis, pitting, and hyperkeratosis, or a personal history of PsO diagnosed by a dermatologist. Clinical characteristics, patient-reported outcomes and treatment patterns were compared between subgroups with and without PsO. Results A total of 83 patients (19.2%) had a personal history of PsO. Patients with PsO were older (48.4 vs. 43.2 years), had a longer diagnostic delay (7.4 vs. 3.5 years), a higher frequency of dactylitis (36.1 vs. 20.0%), and enthesitis (65.1 vs. 55.4%) than patients without PsO (Table 1). A longer diagnostic delay (odds ratio – OR=1.06 [95% CI 1.01-1.11]), lower HLA-B27 positivity (OR=0.31 [95% CI 0.15-0.65]), and higher frequency of enthesitis (OR=2.39 [95% CI 1.16-4.93]) were associated with the presence of PsO in the multivariable logistic regression analysis (Figure 1). Higher patient global assessment scores and lower use of bDMARD treatments were observed in patients without PsO as compared to patients with PsO. Table 1. Demographics and clinical characteristics of patients with pSpA according to the presence or absence of personal history of PsO Total N=433 Patients without personal history of PsO N=350 Patients with personal history of PsO N=83 p-value Age, mean (SD) 44.2 (14.4) 43.2 (14.2) 48.4 (14.5) 0.005 Sex (male) 203/433 (46.9) 167/350 (47.7) 36/83 (43.4) 0.541 Symptom duration of SpA (years), mean (SD) 10.1 (9.5) 9.0 (8.8) 14.4 (10.8) &lt;0.001 Diagnostic delay of SpA (years), mean (SD) 4.3 (6.6) 3.5 (5.9) 7.4 (8.4) &lt;0.001 First- or second-degree relatives with SpA (except psoriasis) 74/433 (17.1) 61/350 (17.4) 13/83 (15.7) 0.871 First- or second-degree relatives with psoriasis 63/391 (16.1) 29/308 (9.4) 34/83 (41.0) &lt;0.001 Patients who fulfilled peripheral ASAS critieria 95/433 (21.9) 74/350 (21.1) 21/83 (25.3) 0.461 Patients who fulfilled CASPAR critieria 81/433 (18.7) 12/350 (3.4) 69/83 (83.1) &lt;0.001 Peripheral articular disease ever 410/433 (94.7) 335/350 (95.7) 75/83 (90.4) 0.059 Any enthesitis in the past confirmed by specific investigations 112/433 (25.9) 81/350 (23.1) 31/83 (37.3) 0.045 Current SPARCC Enthesitis Index score, mean (SD) 0.4 (1.1) 0.3 (0.9) 0.6 (1.6) 0.013 Dactylitis ever 100/433 (23.1) 70/350 (20.0) 30/83 (36.1) 0.003 HLA-B27 positive 197/316 (62.3) 179/269 (66.5) 18/47 (38.3) &lt;0.001 CRP mg/L, mean (SD) 13.9 (25.4) 15.2 (26.9) 8.5 (16.5) 0.019 PGA, mean (SD) 4.5 (2.7) 4.7 (2.7) 3.9 (2.5) 0.018 Local injection of glucocorticoids for peripheral musculoskeletal involvement ever 183/193 (94.8) 156/159 (98.1) 27/34 (79.4) &lt;0.001 csDMARDs ever 384/433 (88.7) 310/350 (88.6) 74/83 (89.2) &gt;0.999 bDMARDs ever 223/433 (51.5) 164/350 (46.9) 59/83 (71.1) &lt;0.001 bDMARDs current 160/433 (37.0) 119/350 (34.0) 41/83 (49.4) 0.011 Categorical variables were given as n/N (%) Figure 1. Association of demographic and clinical characteristics of pSpA with the presence of a personal history of PsO Conclusion The presence of skin PsO has an impact on clinical characteristics of pSpA. pSpA patients without PsO were less frequently treated with bDMARDs despite an comparable or even higher burden of the disease. Acknowledgements No disclosure Disclosure of Interests None declared